Mapping vessels for resecting body tissue

ABSTRACT

A forceps includes a handle, a shaft having a proximal end coupled to the handle, and an end effector assembly coupled to a distal end of the shaft. The forceps includes a first jaw member and a second jaw member for grasping tissue therebetween. One or both of the first and second jaw members may include one or more needles extending therefrom. The one or more needles are in fluid communication with a fluid conduit extending along one or both of the first and second jaw members. The fluid conduit couples to a source of contrast agent to enable selective delivery of the contrast agent through the one or more needles.

CROSS REFERENCE TO RELATED APPLICATION

The present application claims the benefit of and priority to U.S.Provisional Application Ser. No. 62/131,956, filed on Mar. 12, 2015, theentire contents of which are incorporated herein by reference.

TECHNICAL FIELD

The present disclosure relates to surgical devices, systems, and methodsfor performing surgical resection procedures, and, more particularly, tosurgical devices, systems, and methods for mapping vessels duringsegmental resection procedures.

BACKGROUND

In general, resection is a surgical procedure that involves removingbody tissue to combat certain unhealthy body conditions such assuppurative lesions and nonmalignant masses. Some experts also recommendit for removal of cancerous tissue. Segmental resection or segmentectomyis a surgical procedure to remove a portion of body tissue such as anorgan or gland. For example, lung segmentectomy is a procedure thatinvolves removing lung disease, fungal infections, and/or congenitallung malformations without removing excess normal lung. Althoughextensive lung resections such as lobectomy and pneumonectomy mayprovide optimal results, many thoracic patients have chronic obstructivepulmonary disease (COPD) or emphysema and cannot tolerate such extensivelung resections due to their minimal lung reserve. During lung resectionprocedures, clinicians are faced with the challenge of identifying anappropriate line segment for cutting to establish the most suitableresection margin and are often required to speculate as to the locationof the most effective cutting line segment. In this regard, theclinician's conjecture undesirably risks removal of excess normaltissue.

SUMMARY

Accordingly, new devices, systems, and methods for more effectivelyresecting tissue would be useful. In particular, devices, systems, andmethods that enable a clinician to identify precise cut lines throughvessel mapping would facilitate quick and accurate transections, therebymaximizing lung reserve while effectively removing unhealthy tissue.

In one aspect, the present disclosure relates to a forceps including ahandle, a shaft having proximal and distal ends, and an end effectorassembly including a first jaw member and a second jaw member. Theproximal end of the shaft is coupled to the handle and the distal end ofthe shaft is coupled to the end effector assembly.

One or both of the first and second jaw members is movable relative tothe other jaw member between a spaced-apart position and an approximatedposition for grasping tissue therebetween. In embodiments, the first andsecond jaw members each include an electrically-conductivetissue-contacting surface configured to connect to a source of energy totreat tissue grasped between the first and second jaw members.

One or both of the first and second jaw members may include one or moreneedles extending therefrom. The one or more needles are in fluidcommunication with a fluid conduit extending along one or both of thefirst and second jaw members. The fluid conduit may be defined withinone or both of the first and second jaw members. In some embodiments,the fluid conduit extends along an outer surface of one or both of thefirst and second jaw members. The fluid conduit is configured to coupleto a source of contrast agent to enable selective delivery of thecontrast agent through the one or more needles. The one or more needlesmay include a microneedle. In some embodiments, the contrast agent isstored within the handle. The contrast agent may include ultrasoundmarkers, computed tomography markers, magnetic resonance imaging makers,fluorescent markers, or combinations thereof.

According to yet another aspect, the present disclosure is directed to amethod of resecting tissue. The method involves locating a vessel,clamping the vessel to create a boundary for the delivery of a contrastagent to predetermined portions of tissue, injecting the contrast agentinto the vessel, creating images of the tissue based upon the locationof the contrast agent within the tissue, identifying a cut line based onthe images created with the contrast agent, and cutting the tissue alongthe cut line to resect predetermined portions of the tissue.

Injecting the contrast agent into the vessel may include delivering thecontrast agent through one or more needles of an end effector assemblyused to clamp the vessel.

The vessel may be in fluid communication with an organ, a gland, orcombinations thereof. For example, the vessel may be in fluidcommunication with lung tissue and/or with liver tissue. The vessel mayinclude a bile duct.

Other aspects, features, and advantages will be apparent from thedescription, the drawings, and the claims that follow.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the disclosureand, together with a general description of the disclosure given above,and the detailed description of the embodiment(s) given below, serve toexplain the principles of the disclosure, wherein:

FIG. 1 is a perspective view of a surgical system according to theprinciples of the present disclosure with an end effector assembly of aforceps thereof shown in a spaced-apart position;

FIGS. 2A and 2B are enlarged, partial side views of the end effectorassembly of the surgical system of FIG. 1 in various approximatedpositions;

FIG. 3 is a front, elevational view of lung tissue;

FIG. 4 is a front, elevational view illustrating the end effectorassembly of FIG. 2 being used to identify a cut line for resecting thelung tissue;

FIG. 5 is a front, elevational view of another embodiment of a surgicalsystem according to the principles of the present disclosure, thesurgical system being used identify a cut line for resecting the lungtissue;

FIGS. 6 and 7 are progressive views of another embodiment of an endeffector assembly in accordance with the present disclosure; and

FIG. 8 is a schematic illustration of a medical work station andoperating console in accordance with the present disclosure.

DETAILED DESCRIPTION

Particular embodiments of the present disclosure are describedhereinbelow with reference to the accompanying drawings in which likereference numerals designate identical or corresponding elements in eachof the several views. As used herein the term “distal” refers to thatportion of the system, device and/or component(s) thereof, that arefarther from the user, while the term “proximal” refers to that portionof the system, device and/or component(s) thereof, that are closer tothe user. In the following description, well-known functions orconstructions are not described in detail to avoid obscuring the presentdisclosure in unnecessary detail.

Surgical systems in accordance with the present disclosure can includeendoscopic and/or open surgical instruments such as forceps devices,stapling devices, ultrasonic dissection devices, and/or any othersuitable surgical devices. Obviously, different electrical andmechanical connections and considerations apply to each particular typeof device; however, the aspects and features of the present disclosureremain generally consistent regardless of the particular device used.For a detailed discussion of the construction and operation of examplesurgical devices, reference may be made to U.S. Patent ApplicationPublication No. 2013/0267947, U.S. Patent Application Publication No.2013/0255063, U.S. Pat. No. 7,963,431, and/or U.S. Pat. No. 8,444,664,the entirety of each of which is incorporated herein by reference.

In the interest of brevity, surgical systems of the present disclosurewill only be described herein in connection with an endoscopic forceps.

Turning now to FIG. 1, one embodiment of a surgical system 1 includes anelectrosurgical energy source 2 (e.g., a generator or other suitablepower source), a contrast agent source 4 configured to dispense contrastagent (e.g., ultrasound markers, computed tomography markers, magneticresonance imaging makers, fluorescent markers, or combinations thereof),and an endoscopic forceps 10 in communication with the energy source 2and contrast agent source 4. Forceps 10 defines a longitudinal axis“X-X” and includes a housing 20, a handle assembly 30, a rotatingassembly 70, a trigger assembly 80 and an end effector assembly 100. Insome embodiments, contrast agent source 4 can be supported withinforceps 10 (e.g., within housing 20 and/or handle assembly 30). Forceps10 further includes a shaft 12 having a distal end 14 configured tomechanically engage end effector assembly 100 and a proximal end 16 thatmechanically engages housing 20. End effector assembly 100 includesfirst and second jaw members 110, 120. Forceps 10 also includes cable 8that connects forceps 10 to energy source 2; although forceps 10 mayalternatively be configured as a battery-powered device. Cable 8includes a wire (or wires) (not shown) extending therethrough that hassufficient length to extend through shaft 12 in order to provide energyto tissue-contacting surfaces of one or both jaw members 110, 120,respectively. An activation switch 90 is provided on housing 20 forenabling application of selective energy to jaw members 110, 120.

With continued reference to FIG. 1, handle assembly 30 includes a fixedhandle 50 and a moveable handle 40. Fixed handle 50 is integrallyassociated with housing 20 and movable handle 40 is moveable relative tofixed handle 50. In some embodiments, movable handle 40, fixed handle50, and/or housing 20 support a ratcheting assembly 60 that enablesmovable handle 40 to be positioned in a plurality of separate anddiscrete positions relative to fixed handle 50. Rotating assembly 70 isrotatable in either direction about longitudinal axis “X-X” to rotateend effector 100 about longitudinal axis “X-X.” Housing 20 supportsinternal working components (not shown) of forceps 10.

Continuing with reference to FIG. 1, moveable handle 40 of handleassembly 30 is ultimately connected to a drive assembly (not shown)that, together, mechanically cooperate to impart movement of jaw members110 and 120 between a spaced-apart position and one or more approximatedpositions to grasp tissue disposed between jaw members 110, 120. Asshown in FIG. 1, moveable handle 40 is initially spaced-apart from fixedhandle 50 and, correspondingly, jaw members 110, 120 are in thespaced-apart position. Moveable handle 40 is depressible from thisinitial position to one or more depressed positions corresponding to oneor more approximated positions of jaw members 110, 120. For example, insome embodiments, one approximated position can be a clamping positiondefining a first height “H1” between jaw members 110, 210 (see FIG. 2A)and another approximated position can be a sealing position defining asecond height “H2” between jaw members 110, 210 (see FIG. 2B) that isdifferent from first height “H1.” For example, first height “H1” can belarger than second height “H2.” One or more of the approximatedpositions can correspond to one or more of the plurality of separate anddiscrete positions of movable handle 40 relative to fixed handle 50.

In some embodiments, a knife assembly (not shown) is provided. Trigger82 of trigger assembly 80 is operably coupled to the knife assembly (notshown) for selectively translating a knife blade (not shown) through aknife channel 115 defined within one or both of jaw members 110, 120 tocut tissue disposed between jaw members 110, 120.

Referring to FIGS. 2A and 2B, end effector assembly 100 includes aneedle assembly 130 having one or more needles 132 that define distalopenings 132 a. The one or more needles 132 may be sharpened. Needles132 may be microneedles or needles of micro convention size. The needles132 can extend from one or both of first and second jaw members 110,120. Each needle 132 is in fluid communication with a fluid conduit 134that may be defined within one or both of first and second jaw members110, 120. In some embodiments, fluid conduit 134 extends alongside anouter surface of one or both of first and second jaw members 110, 120.Fluid conduit 134 couples to contrast agent source 4 via a contrastagent conduit 6 (see FIG. 1). Fluid conduit 134 and contrast agentconduit 6 may be integrally formed.

In operation as seen in FIGS. 3 and 4, a clinician locates a vessel,which may be a first vessel “V1,” of an organ, gland, or other suitabletissue to clamp with forceps 10 for effectuating a resection procedureand/or for identifying/mapping vessels and/or tissue that the locatedvessel feeds to ensure proper/desired dissection. While forceps 10 isclamped on the located vessel, for example, with needles 132 thereofdeployed and/or retracted, and/or with a separate needless forceps (notshown), a clinician can advantageously determine (e.g., via MRI, CT,etc.) which structures/tissue that would be deprived of blood before anycutting is effectuated. In the illustrated embodiment, tissue “T” islung tissue; however, the presently described devices, systems, andmethods can be applied to any suitable tissue. For example, the firstvessel “V1” may be in fluid communication with liver tissue where thefirst vessel “V1” vessel may include a bile duct.

After locating the first vessel “V1,” the clinician approximates firstand second jaw members 110, 120 to the clamping position (FIG. 2A) toclamp the first vessel “V1” between tissue-contacting surfaces of firstand second jaw members 110, 120. In the clamping position, needles 132puncture the first vessel “V1” so that needles 132 are in fluidcommunication with first vessel “V1.” The clamping of first and secondjaw members 110, 120 to the first vessel “V1” creates a boundary for thedelivery of contrast agent to predetermined portions of the tissue “T.”Contrast agent “CA” is then advanced through fluid conduit 134 and outof needles 132 for delivery into the first vessel “V1.” In this regard,the contrast agent “CA” is fed into one or more secondary vessels “V2”in fluid communication with the first vessel “V1.” The created boundaryprevents the contrast agent “CA” from feeding into one or more vesselsof a blocked area “B.” Images of the tissue “T” can then be created(e.g., CT, MRI, etc.) based upon a location of the contrast agent “CA”within the tissue “T.” In this regard, only the one or more secondaryvessels “V2” in an unblocked area “UB” of the tissue “T” will “light up”on the created image as seen in FIG. 4, effectively mapping the blockedand unblocked areas “B,” “UB” on the created image. If the first vessel“V1” does not provide the desired mapping, the process can be repeatedon other vessels as desired.

With the distinct separation between the blocked and unblocked areas“B,” “UB,” the clinician can identify a cut line “CL” based on theimages created with the contrast agent “CA.” In this regard, the tissue“T” can be quickly and accurately cut (e.g., with a scalpel or othersuitable cutting device) along the cut line “CL” to resect the tissue“T” and efficiently remove any unhealthy tissue while maximizing lungreserve of healthy tissue. After establishing the cut line “CL,” theclinician can further approximate first and second jaw members 110, 120into the sealing position (FIG. 2B) and activate electrosurgical energyfrom the electrosurgical energy source 2 to seal the first vessel “V1”as desired. The forceps 10 can then be removed.

As seen in FIG. 5, another embodiment of a surgical system 1′ includes aforceps 200 and a contrast agent source 202 that is separate anddistinct from forceps 200. In some embodiments, contrast agent source202 can be a syringe filled with any of the presently described contrastagents.

In operation, forceps 200 clamps to the first vessel “V1” and contrastagent “CA” can be delivered to the first vessel “V1” separate fromforceps 200 (e.g., intravenously) without having to pass through forceps200. The contrast agent “CA” can be delivered to the first vessel “V1”before, during, and/or after forceps 200 is clamped to the first vessel“V1.” The cut line “CL” can then be identified and the tissue “T”resected as described above with respect to surgical system 1.

With reference to FIGS. 6 and 7, one embodiment of an end effectorassembly 300 includes a pair of jaw members 310, 320 and one or moreneedles 314 that can be deployed or retracted through one or morechannels 312 defined through jaw member 310 (and/or jaw member 320).Needle 314 may be selectively deployed or retracted relative to jawmember 310 via any suitable drive assembly (not shown). For example, asseen in FIG. 6, needle 314 may be retracted or retained within channel312 when jaw members 310, 320 are open or substantially open (FIG. 6) toprotect vessels and/or tissue from being undesirably punctured, and whendesired (e.g., when jaw members 310, 320 are closed or substantiallyclosed as seen in FIG. 7), deployed as necessary to puncture tissue toenable delivery of a contrast agent or the like through channel 312 ofjaw member 310 and/or through needle 314. In some embodiments, needle314 defines a fluid conduit therethrough configured to receive anddeliver the contrast agent therethrough.

The various embodiments disclosed herein may also be configured to workwith robotic surgical systems and what is commonly referred to as“Telesurgery.” Such systems employ various robotic elements to assistthe surgeon and allow remote operation (or partial remote operation) ofsurgical instrumentation. Various robotic arms, gears, cams, pulleys,electric and mechanical motors, etc. may be employed for this purposeand may be designed with a robotic surgical system to assist the surgeonduring the course of an operation or treatment. Such robotic systems mayinclude remotely steerable systems, automatically flexible surgicalsystems, remotely flexible surgical systems, remotely articulatingsurgical systems, wireless surgical systems, modular or selectivelyconfigurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consolesthat are next to the operating theater or located in a remote location.In this instance, one team of surgeons or nurses may prep the patientfor surgery and configure the robotic surgical system with one or moreof the instruments disclosed herein while another surgeon (or group ofsurgeons) remotely control the instruments via the robotic surgicalsystem. As can be appreciated, a highly skilled surgeon may performmultiple operations in multiple locations without leaving his/her remoteconsole which can be both economically advantageous and a benefit to thepatient or a series of patients.

The robotic arms of the surgical system are typically coupled to a pairof master handles by a controller. The handles can be moved by thesurgeon to produce a corresponding movement of the working ends of anytype of surgical instrument (e.g., end effectors, graspers, knifes,scissors, etc.) which may complement the use of one or more of theembodiments described herein. The movement of the master handles may bescaled so that the working ends have a corresponding movement that isdifferent, smaller or larger, than the movement performed by theoperating hands of the surgeon. The scale factor or gearing ratio may beadjustable so that the operator can control the resolution of theworking ends of the surgical instrument(s).

The master handles may include various sensors to provide feedback tothe surgeon relating to various tissue parameters or conditions, e.g.,tissue resistance due to manipulation, cutting or otherwise treating,pressure by the instrument onto the tissue, tissue temperature, tissueimpedance, etc. As can be appreciated, such sensors provide the surgeonwith enhanced tactile feedback simulating actual operating conditions.The master handles may also include a variety of different actuators fordelicate tissue manipulation or treatment further enhancing thesurgeon's ability to mimic actual operating conditions.

Referring also to FIG. 8, a medical work station is shown generally aswork station 1000 and generally may include a plurality of robot arms1002, 1003; a control device 1004; and an operating console 1005 coupledwith control device 1004. Operating console 1005 may include a displaydevice 1006, which may be set up in particular to displaythree-dimensional images; and manual input devices 1007, 1008, by meansof which a person (not shown), for example a surgeon, may be able totelemanipulate robot arms 1002, 1003 in a first operating mode.

Each of the robot arms 1002, 1003 may include a plurality of members,which are connected through joints, and an attaching device 1009, 1011,to which may be attached, for example, a surgical tool “ST” supportingan end effector 1100, in accordance with any one of several embodimentsdisclosed herein, as will be described in greater detail below.

Robot arms 1002, 1003 may be driven by electric drives (not shown) thatare connected to control device 1004. Control device 1004 (e.g., acomputer) may be set up to activate the drives, in particular by meansof a computer program, in such a way that robot arms 1002, 1003, theirattaching devices 1009, 1011 and thus the surgical tool (including endeffector 1100) execute a desired movement according to a movementdefined by means of manual input devices 1007, 1008. Control device 1004may also be set up in such a way that it regulates the movement of robotarms 1002, 1003 and/or of the drives.

Medical work station 1000 may be configured for use on a patient 1013lying on a patient table 1012 to be treated in a minimally invasivemanner by means of end effector 1100. Medical work station 1000 may alsoinclude more than two robot arms 1002, 1003, the additional robot armslikewise being connected to control device 1004 and beingtelemanipulatable by means of operating console 1005. A medicalinstrument or surgical tool (including an end effector 1100) may also beattached to the additional robot arm. Medical work station 1000 mayinclude a database 1014, in particular coupled to with control device1004, in which are stored, for example, pre-operative data frompatient/living being 1013 and/or anatomical atlases.

Persons skilled in the art will understand that the structures andmethods specifically described herein and shown in the accompanyingfigures are non-limiting exemplary embodiments, and that thedescription, disclosure, and figures should be construed merely asexemplary of particular embodiments. It is to be understood, therefore,that the present disclosure is not limited to the precise embodimentsdescribed, and that various other changes and modifications may beeffected by one skilled in the art without departing from the scope orspirit of the disclosure. Additionally, the elements and features shownor described in connection with certain embodiments may be combined withthe elements and features of certain other embodiments without departingfrom the scope of the present disclosure, and that such modificationsand variations are also included within the scope of the presentdisclosure. Accordingly, the subject matter of the present disclosure isnot limited by what has been particularly shown and described.

What is claimed is:
 1. A method of resecting tissue, comprising:locating a vessel; clamping the vessel to create a boundary for thedelivery of a contrast agent to predetermined portions of tissue;injecting the contrast agent into the vessel; creating images of thetissue based upon the location of the contrast agent within the tissue;identifying a cut line based on the images created with the contrastagent; and cutting the tissue along the cut line to resect predeterminedportions of the tissue.
 2. The method according to claim 1, whereininjecting the contrast agent into the vessel includes delivering thecontrast agent through at least one needle of an end effector assemblyused to clamp the vessel.
 3. The method according to claim 1, whereinthe vessel is in fluid communication with an organ, a gland, orcombinations thereof.
 4. The method according to claim 3, wherein thevessel is in fluid communication with lung tissue.
 5. The methodaccording to claim 3, wherein the vessel is in fluid communication withliver tissue.
 6. The method according to claim 3, wherein the vesselincludes a bile duct.
 7. The method according to claim 1, wherein thefluid conduit extends along an outer surface of at least one of thefirst and second jaw members.
 8. The method according to claim 1,wherein the fluid conduit is defined within at least one of the firstand second jaw members.
 9. A forceps, comprising: a handle; a shafthaving proximal and distal ends, the proximal end coupled to the handle;an end effector assembly coupled to the distal end of the shaft andincluding a first jaw member and a second jaw member, at least one ofthe first and second jaw members movable relative to the other jawmember between a spaced-apart position and an approximated position forgrasping tissue therebetween, at least one of the first and second jawmembers including at least one needle extending therefrom, the at leastone needle in fluid communication with a fluid conduit extending alongat least one of the first and second jaw members, the fluid conduitconfigured to couple to a source of contrast agent to enable selectivedelivery of the contrast agent through the at least one needle.
 10. Theforceps according to claim 9, wherein the at least one needle includes aplurality of needles.
 11. The forceps according to claim 9, wherein thefirst and second jaw members each include an electrically-conductivetissue-contacting surface configured to connect to a source of energy totreat tissue grasped between the first and second jaw members.
 12. Theforceps according to claim 9, wherein the contrast agent is storedwithin the handle.
 13. The forceps according to claim 12, wherein thecontrast agent includes ultrasound markers, computed tomography markers,magnetic resonance imaging makers, fluorescent markers, or combinationsthereof.
 14. The forceps according to claim 9, wherein the at least oneneedle includes a microneedle.